Provider Demographics
NPI:1447058714
Name:BALDERAS, JE-ANN MARIE
Entity type:Individual
Prefix:
First Name:JE-ANN MARIE
Middle Name:
Last Name:BALDERAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 W CYPRESS CREEK RD;
Mailing Address - Street 2:
Mailing Address - City:FORT LAUREDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1525 W CYPRESS CREEK RD;
Practice Address - Street 2:
Practice Address - City:FORT LAUREDALE
Practice Address - State:FL
Practice Address - Zip Code:33309
Practice Address - Country:US
Practice Address - Phone:954-939-5000
Practice Address - Fax:866-993-2244
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11038285367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered